LAUSR

Introduction A group of patients with gastro-oesophageal reflux disease (GORD) also have oesophagogastric outflow obstruction (OGJOO) condition. Given the nature of the motility disorder, treatment of GORD in these patients would differ from GORD being caused by an incompetent GOJ. In this study we assess the GORD mechanism in patients with OGJOO. Method Patients were screened between 2015 to 2018 with 24hr impedance-pH monitoring and high-resolution manometry (HRM) testing. Two groups of GORD patients were selected: patients also having OGJOO (group I) and patients having normal oesophageal motility (group 2). The manometry assessment for OGJOO and normal motility was based on Chicago classification [1]. Results Total number of patients selected was 66: group 1 (F:M=21:7; age 4–0 years) and group 2 (F:M=27:11; 2–8 years). Group 2 showed significantly higher acid reflux count (47.2 vs 32.1, p=0.0036) and a ratio of acid exposure time per acid reflux episode which significantly higher in group 1 (8.0 mins/episode vs 3.1 mins/episode, p=0.0215). The total acid exposure between group 1 and group 2 was not significantly different (percent clearance time on pH was 10.2% vs 9.3% [p=0.2372] and acid exposure time was 139.24mins vs 121.10mins [p=0.1536]). Conclusion There is indication that mechanism of GORD in OGJOO is mainly due to poor clearance of acid. Therefore, patients with GORD concurrent with OGJOO condition may benefit from improved oesophageal clearance, such as with OGJ dilatation opposed to antireflux surgery. This study was limited by the sample size. Reference Kahrilas PJ, et al. The Chicago Classification of Esophageal Motility Disorders, v3.0Neurogastroenterol Motil 2015;27(2):160–174.